The Trap of Anxiety and Trauma
/By Concentric Owner Jennifer Larson, LCPC, NCC
This blog post was originally posted on the Anxiety Relief Project’s website as the Founder was asked to be an expert contributor. The Anxiety Relief Project and website are no longer active. Jennifer Larson, LCPC, NCC is the Owner of Concentric Counseling & Consulting, a private practice group in Chicago that specializes in relationship and couples struggles; tween, adolescent and family issues; complex and relational trauma; anxiety, depression and bi-polar disorders; mind-body connection; life transitions and stress; the self and identity; substance abuse; and unresolved family-of-origin issues. Jennifer has experienced complex trauma, anxiety, and post-traumatic growth and is passionate about helping others who have endured similar struggles. Over the past 2 years, Jennifer has started sharing more about her personal struggles and growth in an effort to help de-stigmatize mental health.
Driving my car in my early adult years filled me with freedom and curiosity. Didn’t matter if I was driving by myself, on city streets, highways or traversing the deserts of Arizona, I loved driving. Toggling between radio stations to find the right tune, opening up the windows to feel the fresh air hitting my face and throwing my hair around, hanging out with my thoughts, or being mesmerized by the pink and purple hues of Arizona’s sunsets were met and felt with ease, peace, and freedom. Fast forward several years later, and my experience of driving catapults me into feelings and sensations of feeling trapped and crippled by anxiety, panic attacks, and at times, dissociation.
White-knuckling my steering wheel bound by the perpetual ticking of the clock, shouting at me to be here and there at this time. “Hurry up!” is my internal mantra. Truth be told, my life was definitely more stressful during that time. Let’s face it, chronic stress does not do anyone any favors, much less me who has endured the impact of years of complex trauma and its anxieties that are married to it.
It started with commuting on I-90 expressway in Chicago as I began to feel a tinge of anxiety and thoughts about possibly becoming trapped in gridlocked traffic with no easy way to escape. The first spider silk strand of anxiety over time grew and grew into an unwieldy, dense web that ended up trapping me. Inching closer as I merged onto the express lane, I experienced frantic and dreadful panic as I imagined being stuck in the express lanes flanked by 4 rows of cars on either side of me where escape was next to impossible. Knowing the gift of extra time – a much coveted commodity - would be more favorable to me if I chose the express lane during my commutes. However, I now found myself avoiding it all together because my anticipatory anxiety of driving in the express lane, even the night prior, crept in and simply took over me.
Avoiding the express lane did mitigate my anxiety, but it was a temporary solution at best. The same level of anxiety and panic now started to emerge when driving on the regular lanes on the highway. My heart-racing, tingling sensations in my lower legs, sweating hands and unfriendly thoughts befriended me. Panic attacks started to fuse into a strange hybrid of disconnect and escape sensations. I wish I were describing a feel-good, daydream-state of imagining being in a beautiful place that evokes happiness and ease, but this type of disconnect and escape experience that later emerged is called dissociation.
When dissociation occurred, I would experience a sense of not feeling attached or even inside of me, but rather sucked into a vast abysmal, ominous space from above me. This experience was the most terrifying of them all. Other times, I would experience my surroundings as a surreal place, almost as though the cars and buildings were toy-like, not real. These experiences felt like transactional moments as if I was holding onto a roll of processed film looking at each frame-by-frame. During these times, I was not embodied, but rather detached from myself as I experienced both de-personalization and de- realization which are dissociative states. These were all very new experiences for me.
Drifting in and out of anxiety, panic, and dissociation soon became more commonplace. Perpetual thoughts and sensations of being revved up, anxious, scared, wanting to escape, and seeking a place of refuge became a part of my lived experiences.
This Is The Trap of Anxiety and Trauma
Learning about the connection of anxiety and trauma from a neurobiological or neuroscience perspective greatly helped to illuminate and normalize my experiences of anxiety and traumatic stress, and allowed me to move from being the driver to a driving instructor. I started to understand how my own past complex trauma coupled with chronic stress impacted my health. This knowledge also helped me in my own therapy journey as well as with helping my client’s. To better understand the neuroscience of anxiety and trauma, let’s first begin with a basic understanding of human’s nervous system and the brain.
The Triune Brain
There is some debate around this; some people believe in the triune or 3-part brain model, while others believe this is too simplistic. For brevity sake, let’s look at the different parts of the triune brain and its respective functions:
• Brain stem: This is often referred to the reptilian or primal part of the brain which is responsible for instincts, survival and autonomic body processes, such as breathing, eating, blood pressure, sleep, and regulating the central nervous system.
• Mid-brain: This is where the limbic system is housed and is often referred to the mammalian or emotional part of the brain. The limbic system is largely responsible for processing emotions and feelings, implicit memory, sensory somatic experiences, and hormonal secretions. The amygdala plays a role in autonomic responses to fear. The hippocampus plays a role in memory.
• Fore-brain: This is where the neocortex is located and is often considered the Homo Sapiens, modern or highly evolved part of the brain. This part is responsible for processing intellectual, language, abstraction, and executive functioning, such as decision-making. The dorsolateral prefrontal cortex is the time-keeping part of the brain.
The Nervous System
The nervous system has 2 parts - the limbic system and the autonomic nervous system. The limbic system is a portion of the brain that deals with the functions of our emotions, memory formation, and arousal. The limbic system consists of the hypothalamus, the hippocampus, the amygdala, and several other structures. The hippocampus helps to regulate our autonomic nervous systems by regulating our breathing, blood pressure, pulse, and arousal in response to emotional circumstances. The amygdala plays a role in autonomic responses to fear and the hippocampus plays a role in memory, such as converting short-term memory into long-term memory.
The autonomic nervous system is composed of 2 opposing parts: the sympathetic nervous system (arousing) and parasympathetic nervous system (calming). When both systems our in sync, we feel
balanced and centered. The sympathetic part our system is highly involved when we face a threat or something dangerous as it enables us to go into “fight or flight” mode. Eventually, the opposing parasympathetic system helps bring our nervous system back to a state of calm and relaxation. For people who feel too much sympathetic arousal, the parasympathetic system can take over causing a person to go into “freeze of collapse” mode, otherwise known as shutdown. In the shutdown mode, the dorsal vagal, parasympathetic system is activated causing a person to dissociate, faint, or become immobile. This survival mechanism is similar to an animal that lies completely still, feigning its death hoping for the predator to go away.
Anxiety
Anxiety is a psychological and physiological response to fear, danger, or threat. When we are faced with a threat – a real or perceived threat - or memory that reminds us of former threat, our nervous system swiftly responds through an intricate and interconnected network by going into fight-flight-freeze-or collapse mode. The amygdala gets activated, certain hormones are secreted pouring into the body, and the body is primed to behaviorally respond in either fight-flight-freeze-or collapse mode. This amygdala activation is akin to a smoke detector going off when there is an excess of smoke that is trapped in a home. The alarm system goes off to warn and signal people to get out of a dangerous situation. As in the case with anxiety or trauma, actual smoke or perceived smoke trip the smoke detectors to go off.
Many studies have shown there is a link between what happens in one’s nervous system and those who suffer from anxiety. For instance, when a person is faced with a fear or even a conditioned fear (such as arachnophobia or any other type of phobia), the amygdala is activated, signaling to the person’s body that they are in danger. Neuroscience explains what occurs within the brain and autonomic nervous system. Therapy can help people understand how anxiety impacts 4 areas: cognitions (or thoughts), emotions, physical sensations, and behaviors. To illustrate, a person who has social anxiety (or fear of public speaking) may think others will judge or criticize them, feel insecure and embarrassed, have physical sensations of heart racing, dry mouth, shallow breathing, and behaviorally may pace back-and-forth when speaking. A person who suffers from panic attacks might think they are going crazy, feel overwhelmed and anxious, experience intense and overwhelming physical sensations, and may behaviorally try to escape their environment. All of these examples of anxiety involve the nervous system. Similarly, those who suffer from traumatic stress experience thoughts, emotions, behaviors, and sensations as those with anxiety.
Trauma
Trauma involves a loss of choice in which a person faces a single dangerous event, series of overwhelming threats (or neglect) or when a person recalls threatening memories in which that person feels unsafe or trapped. Not everyone who faces a threat or something dangerous will experience traumatic stress, but for those who do, their autonomic nervous system continues to be in a longer-term state of dysregulation. People who have a traumatic response may find daily life as threatening even if there is no actual or rational threat present. Studies* have shown the dorsolateral prefrontal cortex or the time-keeping part of the brain goes offline and shuts down, consequently, the traumatic memory
and internal experience feels like it is perpetually present (*nicamb, National Institute for the Clinical Application of Behavioral Medicine, Treating Trauma Master Series). People who suffer from Post Traumatic Stress Disorder (PTSD) or Complex Trauma (C-PTSD) share feeling unsafe, trapped, crippled, or limited.
In addition to feeling anxious, people with traumatic response can also become disembodied and detached from oneself by route of dissociation. When someone dissociates, the dorsal vagal nerve shuts down and immobilizes the body. As people have described (and I surely can attest), it feels like one has been hijacked or assaulted from within.
For me, I found driving on the highway with limited ability to escape as threatening. It didn’t matter if it was a real or perceived because my mind and body responded as though it was a real threat. It is critical that our built in alarm systems in the brain and body respond when faced with real threats so we can find a way to escape them and ultimately survive in the end. But as you may suspect, it’s not so good when our alarm systems are going off constantly when there are no or minimal threats.
Once the threat retreats or we are able to thwart off the threat, for some people, their body discharges the excess energy caused by hormonal secretions that had been initially resourced and ignited to return back to a state of balance and integration. This is a healthy response as people can function well and go back to business as usual with a sense of ease, mobility, curiosity, and even play. However, for some other people, as in the case with me, people who face anxiety, chronic stress, or trauma, this discharge of energy does not occur, but rather the brain and body are stuck in a recycling and dysregulation mode. In these occurrences, people walk through life seeing, feeling, or sensing threats around them as though they are walking in a minefield, which in turn, constantly pulls on those internal alarm systems, secreting and overloading the system with hormones, and maintaining dysregulation.
Free Yourself from The Trap of Anxiety and Trauma
Knowledge and research provides concrete explanations as to what happens to people when faced with anxiety, chronic stress, and trauma. And, research has demonstrated what can help people manage and overcome its impact. Knowledge is power. There are a number of respectable and beneficial treatment options, both traditional and non-traditional. I do not believe in a one-size-fits-all approach. Medications, supplements, and a healthy diet are important considerations. Mental health therapy, both top-down and bottom-up approaches are helpful remedies, such as Cognitive Behavioral Therapy (CBT), Somatic Experiencing (SE), Prolonged Exposure Therapy (PE), and Sensorimotor Psychotherapy. Learning how to practice being in the here-and-now with mindfulness, meditation, and grounding techniques is useful. Good sleep and exercise are essential. And, of course, surrounding yourself with healthy, safe people and spending time in nature and spirituality are key. I can personally attest to the power and effectiveness of an integrated approach to escaping the trap of anxiety and trauma. Your options are limitless and there is hope for healing.
I would like to acknowledge the following professionals as my blog post draws from the expertise, work, and writings of Bessel van der Kolk, MD, Stephen Porges, Ph.D., Pat Odgen, Ph.D., Peter Levine, Ph.D., Dan Siegel, MD, Ruth Lanius, MD, Ph.D, Paul Maclean, MD, David Carbonell, Ph.D., C. George Boeree, Ph.D., David Puder, MD, and nicamb, National Institute for the Clinical Application of Behavioral Medicine, Treating Trauma Master Series.